Organization
BLOOMINGTON LAKE CLINIC, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA J BARGER (ASSISTANT ADMINISTRATOR)
(612) 277-2165
Entity
Organization
Contact information
Practice address
7901 XERXES AVE S STE 116, BLOOMINGTON, MN 55431-1200
(952) 888-2024
(952) 888-3985
Mailing address
7901 XERXES AVE S STE 116, BLOOMINGTON, MN 55431-1200
(952) 888-2024
(952) 888-3985
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
23
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1713
HEALTH PARTNERS
MN
05
—
302510100
—
MN
01
—
C406
UCARE MINNESOTA
MN
Enumeration date
12/18/2006
Last updated
04/04/2011
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